Glen K Stephenson Dmd Chartered

NPI #1265692321 in Boise, Idaho

Provider Information

NPI Number: 1265692321
Entity Type: Organization
Organization Name: Glen K Stephenson Dmd Chartered
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 12, 2008
Last Updated: Jun 12, 2008

Practice Location

Address: 7480 NORTHVIEW ST
City: Boise
State: Idaho
ZIP Code: 83704-7232
Phone: (208) 375-4041

Authorized Official

Name: DR. GLEN K STEPHENSON, DMD
Title: PRESIDENT
Phone: (208) 375-4041

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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